Assessment in counseling chapter 6

∗ Demographic Information∗ Client Background Information ∗ Health and Medical History ∗ Client’s Presenting Concerns ∗ Other Relevant Information Information Gathered in Initial Intervie

Initial Assessment in Counseling

Chapter 6

∗ Demographic Information

∗ Client Background Information

∗ Health and Medical History

∗ Client’s Presenting Concern(s)

∗ Other Relevant Information

Information Gathered in Initial Interview

1. Explore each significant problem from multiple perspectives

2. Gather specific information on each major problem

3. Assess each problem’s intensity

4. Assess the degree to which the client believes each problem is changeable

5. Identify methods the client has previously used to solve the problem

Defining the Client’s Problem

Prochaska et al.’s Transtheoretical Model:

1. Precontemplation

2. Contemplation

3. Preparation

4. Action

5. Maintenance

Assessing the Change Process

∗ Consider credibility: Does counselor appear trustworthy, expert, attractive?

∗ Open-ended vs closed-ended questions

∗ Commonly used techniques: Paraphrasing, clarifying, reflecting, interpreting, summarizing

∗ Verbal and nonverbal behaviors

Interviewing Skills and Techniques

∗ Establish rapport and familiarity

∗ Adjust questions to child’s developmental level

∗ Ask questions in a warm professional manner

∗ Explain reason for asking questions

∗ Define limits of confidentiality

∗ Structure interview to be developmentally appropriate (use physical props, games, toys, etc.)

∗ Use variety of question types; avoid abstraction

∗ Do not stop child’s disruptive behavior too quickly; observe

Interviewing Children

∗ Structured: established set of questions asked in same manner and sequence to each client

∗ Unstructured: counselor has idea of possible items but conducts interview in a unique manner depending on the client’s needs

∗ Semi-structured: combination of structured and unstructured; certain questions are always asked, but there is room for exploration and additional questions

Types of Interviews

∗ Checklists

∗ Standardized

∗ Informal

∗ Rating scales

∗ Standardized

∗ Informal

Other Strategies Used in Initial Assessment

∗ Suicide is 10th leading cause of death in the U.S (NIMH, 2010)

∗ 71% of counselors have worked with individuals who had attempted suicide; 28% of those practitioners had a client who had committed suicide (Rogers et al., 2001)

∗ Risk factors vs warning signs

Assessment of Suicide Potential

Assessment of Suicide Potential: Warning Signs & Risk Factors

Warning Signs

∗ Imminent or pressing danger; individual

should be evaluated for possible

intervention

∗ Tier 1

∗ Tier 2 (Rudd et al., 2006)

Risk Factors

∗ General picture indicates long-term risk for suicide attempt

∗ Risk factors often associated with demographic characteristics

∗ Gender

∗ Race/ethnicity

∗ Adolescent suicide - 3rd leading cause of death among 15-24 year olds

Assessment of Suicide Potential

∗ Other factors:

∗ Drug/alcohol use

∗ Depression – hopelessness/helplessness

∗ Previous attempts

∗ Recent loss, divorce, or separation

∗ Personality factors

∗ History of psychiatric disorder

∗ Personality disorder

∗ “Protective” factors

Assessment of Suicide Potential

∗ Suicide Potential Instruments:

∗ Suicide Probability Scale (Cull & Gill, 1992)

∗ Beck Scale for Suicide Ideation (Beck & Steer, 1991)

∗ Beck Hopelessness Scale (Beck & Steer, 1993)

∗ Suicidal Ideation Questionnaire (Reynolds, 1988)

∗ Adult Suicidal Ideation Questionnaire (Reynolds, 1991)

Assessment of Suicide Potential

∗ Assess level of depression with every client (Morrison, 2007)

∗ Know the symptoms – cognitive, affective, behavioral/ physical

∗ Assess severity and type of depression

∗ Some formal instruments:

∗ Beck Depression Inventory-II (Beck, Steer, & Brown 1996)

∗ Children’s Depression Inventory-2003 Update (Kovacs, 2003)

∗ Children’s Depression Rating Scale-Revised (Poznanski & Mokros, 1996)

∗ Hamilton Depression Inventory (Reynolds & Kobak, 1995)

Assessment of Depression

∗ In most mental health settings, 29% - 50% of individuals seeking services will also have substance use disorder (Adesso et al., 2004)

∗ Assessing substance use is needed throughout counseling process if counselor detects possibility of problem

∗ Explore alcohol use and drugs taken (prescription, over-the-counter, street drugs)

∗ Substances used & amount taken

∗ Social & interpersonal aspects

∗ Internal & external triggers

Assessment of Substance Abuse

∗ Motivational Interviewing

∗ 4 general principles: express empathy, develop discrepancy, roll with resistance, support self-efficacy

∗ Substance Abuse Subtle Screening Inventory 3 (SASSI-3)

∗ SASSI-A2 for adolescents

Assessment of Substance Abuse: Methods & Instruments

∗ CAGE interviewing technique (Mayfield, McLeod, & Hall 1974)

1. Have you ever felt you need to cut down on your drinking?

2. Have people annoyed you by criticizing your drinking?

3. Have you ever felt bad or guilty about drinking?

4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover

(eye opener)?

∗ “acid test” method

Assessment of Substance Abuse: Methods & Instruments

∗ Used to describe client’s level of functioning and self-presentation

∗ Generally conducted during initial session/intake interview

∗ Usually organized around: (Trzepacz & Baker, 1993)

∗ Appearance, attitude, and activity

∗ Mood and affect

∗ Speech and language

∗ Thought process, thought content, and perception

∗ Cognition

∗ Insight and judgment

Mental Status Examination

(Polanski & Hinkle, 2000)